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Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies:A review of the literature

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World Journal of Gastroenterology 2008年第9期14卷 1463-1466页

作者： Javier Molina-Infante Lucía Ferrando-Lamana Jose mar.a Mateos-Rodríguez Belén Pérez-gallardo ana Beatriz Prieto-Bermejo Unit of Gastroenterology Hospital San Pedro de Alcantara Avda. Pablo Naranjo s/n 10003 Caceres Spain Department of Pathology. Hospital San Pedro de Alcantara Avda. Pablo Naranjo s/n 10003 Caceres Spain

Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.

关键词： Eosinophils Eosinophilic esophagitis Gastroesophageal reflux Proton pump inhibitors Overlap

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Changes in the Rate of Human Papilloma Virus Serotypes after Vaccine Implementation: A Descriptive Study

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Open Journal of Obstetrics and Gynecology 2023年第5期13卷 934-949页

作者： ana mar.a colino gallardo Montserrat de la Torre Serrano Lone Nielsen Alejandro Pascual martín Concepción Millana de Ynes mar.a Jesús González Fuensalida Patricia Barreiro Sanabria Eva Rodríguez Escudero Dolores García López Aranzazu Gómez Rodríguez Rosa Rodero Villanueva mar.a Jesús Fernández Aceñero Department of Surgical Pathology Hospital Clínico San Carlos Madrid Spain Department of Surgical Pathology Hospital Universitario del Sureste Madrid Spain Grupo de Investigación en anatomía Patológica Hospital Clínico San Carlos IdISSC Madrid Spain Department of Legal Medicine Psychiatry and Surgical Pathology Complutense University of Madrid Madrid Spain

Background: The main objective of this study is to describe the rate of the different serotypes of HPV in cervical cytologies and biopsies in three different periods: 2002-2006 (prior to the implementation of the vaccination programs in Spain), 2009-2011 (shortly after this implementation) and 2020 (almost 15 years after introduction of the vaccine) at a single hospital. Methods: This is an observational, descriptive, retrospective study based on the review of the results of the determination of the HPV serotype using the commercial kit (Genomica®;Pharmamar LTD) in cervical liquid-based cytologies and biopsies at a single large tertiary hospital, Hospital Clínico San Carlos, in Madrid, Spain. We have collected the data from three different time periods: 2002-2006;2009-2011, and 2020 to try to understand the potential changes associated with the use of the vaccine. Results: In these time periods we have reviewed the data from 1420 women. In the three periods the most frequent serotype was HPV 16, followed by HPV 18 or a combination of both. The most frequent low risk serotype was HPV 6 followed by the combination of HPV 6 and 11. It has been verified in our study that the prevalence of the category “others”, constituted by the three risk groups, has undergone a progressive increase, beginning with an infection rate of 65.43% in 2002-2006 to finally rise up to 90.92% in the year 2020. Conclusions: Our study reveals an increase in the number of infections by the HPV serotypes that are not included in the tetravalent vaccine.

关键词： HPV Serotypes Cervix Vaccine Women’s Health

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Evolution of Cervical Lesions Associated with Human Papillomavirus Infection after the Introduction of Vaccination

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Open Journal of Obstetrics and Gynecology 2023年第8期13卷 1307-1323页

作者： Montserrat de la Torre ana mar.a colino Lone Nielsen Alejandro Pascual Concepción Millana mar.a Jesús González Patricia Barreiro Eva Rodríguez Dolores García Aranzazu Gómez Rosa Rodero mar.a Jesús Fernández Department of Surgical Pathology Hospital Clínico San Carlos Madrid Spain Department of Surgical Pathology Hospital Universitario del Sureste Madrid Spain Grupo de Investigación en anatomía Patológica Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos Madrid Spain Department of Legal Medicine Psychiatry and Surgical Pathology Complutense University of Madrid Madrid Spain

Background: The main objective of this study is to analyse the change in the type of lesions developed by HPV-infected patients after the introduction of the vaccine in three different periods;2002-2006 (years previous to the implementation of the vaccine in Spain), 2009-2011 (shortly after the vaccination) and 2020-2021 (years where the vaccine was well established) at a single hospital. Methods: This is an observational, descriptive, retrospective study based on the review of the results of the biopsies of patients with HPV lesions at a single large tertiary hospital, Hospital Clínico San Carlos, in Madrid, Spain. We have collected the data from three different time periods: 2002-2006, 2009-2011, 2020-2021 to try to understand the potential changes in these lesions after vaccine introduction. Results: In this time we have reviewed the data from 946 women. In these three periods, a decreasing trend in the rate of squamous cell carcinoma was noted, the rate of adenocarcinoma remains stable, and the rate of cervical intraepithelial neoplasia grades 2 - 3 (CIN 2-3) lesions shows an increasing trend. We have also found a change in the mean ages of the patients with these lesions, as this increased in the three lesions caused by HPV after the implementation of the vaccine. Our study indicates that the identification of other high risk serotypes, apart from 16 and 18, as well as those with indeterminate risk, has undergone a progressive increase, increasing from 24.24% and 14.11% respectively in 2002-2006 to 40.42% and 28.34% in 2020-2021. Conclusion: Our study confirms the effectiveness of the vaccines developed so far, against the HPV serotypes they contain. This is demonstrated by the evidence, in our population, of a decrease in the incidence of squamous cell carcinoma in uterine cervix. In parallel, an increase in the mean age of diagnosis has been verified, for both squamous cell carcinoma and its CIN 2-3 precursor lesions, as well as a change in the infective tren

关键词： HPV Serotypes Cervix Vaccine CIN 2 - 3 Squamous Cell Carcinoma Women’s Health

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Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction

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Journal of Geriatric Cardiology 2024年第10期21卷 954-961页

作者： Albert Ariza-Solé Juan Andrés Bermeo Francesc Formiga Héctor Bueno Gemma Miñana Oriol Alegre David martí Manuel martínez-Sellés Laura Domínguez-Pérez Pablo Díez-Villanueva JoséA Barrabés Francisco marín Adolfo Villa marcelo Sanmartín Cinta Llibre Alessandro Sionís Antoni Carol Sergio García-Blas mar.a JoséMorales gallardo Jaime Elízaga Iván Gómez-Blázquez Fernando Alfonso Bruno García Del Blanco Julio Núñez Juan Sanchis Cardiology Department Hospital Universitari de BellvitgeL’Hospitalet de LlobregatBarcelonaSpain Internal Medicine Department Hospital Universitari de BellvitgeL’Hospitalet de LlobregatBarcelonaSpain Centro Nacional de Investigaciones Cardiovasculares(CNIC) MadridSpain.Cardiology DepartmentHospital 12 de Octubreand Instituto de Investigación Sanitaria Hospital 12 de Octubre(imas12)MadridCIBERCVMadridSpain.Universidad ComplutenseMadridSpain Cardiology Department Hospital Clínico Universitario de ValenciaINCLIVAUniversidad de ValenciaCIBERCVValenciaSpain Cardiology Department Hospital Central de la DefensaMadridSpain Cardiology Department Hospital Universitario Gregorio MarañónCIBERCVUniversidad ComplutenseUniversidad EuropeaMadridSpain Cardiology Department Hospital Universitario La PrincesaIIS-IPCIBERCVMadridSpain Cardiology Department Hospital Universitari Vall d’HebronCIBERCVBarcelonaSpain Cardiology Department Hospital Virgen de la ArrixacaCIBERCVEl PalmarMurciaSpain Cardiology Department Hospital Universitario del SuresteArganda del ReyMadridSpain Cardiology Department Hospital Ramon y CajalCIBERCVMadridSpain Cardiology Department Hospital Germans Trias i PujolCIBERCVBadalonaBarcelonaSpain Cardiology Department Hospital Sant PauCIBERCVBarcelonaSpain Cardiology Department Hospital Moisés BroggiSant Joan DespíBarcelonaSpain

Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical *** The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative *** primary endpoint was the number of days alive and out of hospital(DAOH)one year after *** this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)*** Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive ***:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative *** contrast,the-re were no differences in the subgroup with CFS=*** Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.

关键词： routine invasive infarction

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